Although it has been observed that patients describe marked symptomatic benefit and improved exercise capacity 2-4 years after the performance of percutaneous transluminal coronary angioplasty (PTCA), little data is available documenting anatomic and functional results during long-term follow-up. Thus, 46 of the first 53 patients who had a successful procedure, and had not had clinical or anatomical evidence of restenosis in the first 9 months after the procedure, were reevaluated at an average of 37 months after their last successful procedure. At follow-up patients underwent cardiac catheterization, treadmill exercise testing and radionuclide angiography at rest and with exercise. The percent diameter narrowings pre-PTCA was 66 plus/minus 13% and improved to 30 plus/minus 13% immediately after the procedure. It was 26 plus/minus 16% six months later and 19 plus/minus 13% at late follow-up. Each successive measurement was statistically significantly less than the narrowing found at the previous study. Treadmill exercise time was 9.8 plus/minus 4 minutes pre-PTCA and improved to l8.3 plus/minus 4.6, and 18.2 plus/minus 4.5 minutes at the three respective post-PTCA studies. No significant change occurred in rest LV ejection fraction (EF) after PTCA, but exercise LVED, which had fallen by 4 plus/minus 6% pre-PTCA (compared to rest) rose after PTCA by 7 plus/minus 7, 6 plus/minus 7, and 4 plus/minus 7% respectively. Twenty-two patients showed a greater than 10% decrease in the amount of narrowing at the angioplasty site between the six month and three year studies. Six patients developed new significant stenoses at nondilated sites during follow-up. These results indicate that the short-term anatomic and functional success after PTCA is maintained for at least three years, even though disease occasionally progresses at other sites.